SCANSECT 2012, Vilnius

Transcription

1 SCANSECT 2012, Vilnius

2 SCANSECT 2012, Vilnius

3 SCANSECT 2012, Vilnius

4 SCANSECT 2012, Vilnius Serum cystatin C and serum creatinine after cardiopulmonary bypass with and without leukocyte filtration of mediastinal shed blood A pilot study Anders Svensson RN. MS. CCP 1, Magnus Rosén RN. MS. CCP 2, Ingemar Cederholm MD. PhD 2, Csaba P Kovesdy MD. FASN 3, Zoltán Szabó MD. PhD 4 1 Department of Cardiothoracic and Vascular surgery, University Hospital Linköping, County Council of Östergötland, Sweden, University of Aarhus, Denmark 2 Department of Cardiothoracic and Vascular surgery, University Hospital Linköping, County Council of Östergötland, Sweden 3 Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, VA USA. Division of Nephrology, University of Virginia, Charlottesville, VA USA 4 Department of Cardiothoracic and Vascular surgery, University Hospital Linköping, County Council of Östergötland, Sweden Department of Medical and Health Science, Faculty of Health Science, Linköping University, Sweden

5 Introduction Post-ischaemic reperfusion Co-morbidity Exo- and endogenous toxins Haemodynamic factors Disturbed adrenergic and RAS activation Type of surgical procedures Nephrotoxic drugs Systemic vasodilatation Low cardiac output Microembolisation High age Immunological response Oxidative stress Time on CPB

6 Aim The purpose of this pilot study was to investigate the effect of the separation and leukocyte depletion of cardiotomy suction blood on the dynamics of s-cystatin C and s-creatinine in patients with normal preoperative kidney function. With focus on the first 72 hours post cardiopulmonary bypass.

7 Distribution of surgical procedures Surgical procedure Non-filtered group n=9 LG6-group n=10 Total Mitral and tricuspid valve repair Mitral and tricuspid valve repair, AVR, CABG x1 1 1 MVR, CABG x1 1 1 Mitral and tricuspid valve repair, CryoMaze ablation 2 2 Mitral and tricuspid valve repair, PFO closure 1 1 MVR, AVR, CryoMaze ablation 1 1 AVR, Supra-coronary ascending aorta replacement, CABG x3 1 1 Mitral and tricuspid valve repair, AVR, CryoMaze ablation 1 1 AVR, CABG x AVR, CABG x MVR, tricuspid valve repair, CABG x4 1 1 AVR, CABG x6 1 1 MVR, CABG x2 1 1 AVR, CABG x2 1 1 Total 9 10 n=19 Distribution of surgical procedures in non-filtered and blood filtered with LG6 leukocyte depletion filter. AVR=Aortic Valve Replacement, CABG=Coronary Artery Bypass Grafting, MVR=Mitral Valve Replacement. PFO=Patent Foramen Ovale. CryoMaze ablation for treatment of atrial fibrillation.

8 CBP Set up Photo: U Wallgren

9 Baseline Post CPB 6h post CPB 3h post CPB 12h post CPB 24h post CPB 48h post CPB 72h post CPB Timetable for bloodsampling S-Creatinine och s-cystatin C were measured preoperatively and 72 hours post cardiopulmonary bypass.

10 Cardiotomy suction, volumes (ml) Shed blood post x-clamp Shed blood per x-clamp Shed blood pre x-clamp

11 S-cystatin C S-cystatin C values [mg/l] without LDF (blue line) and with LDF (red line). Values as mean ±SEM

12 S-creatinine S-creatinine values [µmol/l] without LDF (blue line) and with LDF (red line). Presented with mean ±SEM

13 S-creatinine and s-cystatin C correlation Correlations between s-creatinine and s-cystatin C in the whole group of patients n=19 as tested with Spearman correlation test.

14 Conclusion No significant differences in s-cystatin C and s-creatinine levels between the groups (filter vs. non-filter). No significant difference in time between s-cystatin C och s-creatinine. S-cystatin C and s-creatinine showed increasing correleation from three hours up to twelve hours, and stabile after then.

15 Limitations Small sample pilot study Only patients with normal or near normal kidney function No inflammatory or immunological biomarkers Focus on the first 72 h post CPB

16 Thank you for your attention Rondane National Park, Norway. Photo: A Svensson